GOP Outlines Post-Election Healthcare Plans

by David Pittman David Pittman,Washington Correspondent, MedPage Today
August 30, 2012

TAMPA, Fla. -- Mitt Romney will completely repeal the Affordable Care Act (ACA) and start a bit-by-bit approach at his own reforms if he's elected president, his top health policy advisor said here this week.

While some conservative policymakers agree there are reforms in the ACA worth keeping, a piecemeal approach is a better solution both legislatively and in implementation, Matt Hoffman, senior policy adviser for the Romney campaign, said at a healthcare town hall held at the Republican National Convention.

The ACA was a 2,700-page bill that was jammed through Congress without bipartisan support, Republicans complain. "When you take that approach, all of a sudden things get lost in the mix," Hoffman said.

Even if Republicans win only a slim majority in the Senate this November, conservative lawmakers could repeal the ACA with Romney in the White House. Democrats currently hold a 51-47 advantage in the Senate, with 2 independents.

"I actually wonder if we couldn't get a Democratic senator or two who is up for reelection in 2014 to vote with the Republicans on the Senate side and that bill could be ready for Gov. Romney as soon as he comes in from the inauguration," said Rep. Mike Burgess, MD, (R-Texas) said.

Speaking at the same town hall meeting, Burgess said that the first bill Romney could sign into law would repeal "large portions" of the ACA. That begs the question which reforms are worth keeping.

Mandates for insurance companies to cover preexisting conditions and keep dependents on plans up to age 26 are some proposals that have gained bipartisan support.

Hoffman said Romney also supports allowing interstate shopping for insurance and caps on medical liability claims.

The Romney campaign is also now championing the transformation of Medicare into a premium-support system, which congressman and vice presidential candidate Paul Ryan (R-Wis.) has proposed. His idea has drawn great debate during the campaign. Hoffman was a health policy staffer for Ryan.

Even if Democrats maintain some sort of control in the Senate and White House or are able to stave off an ACA repeal, the law could come under fire in a budget-conscious Congress because of its high cost, Burgess said.

Lawmakers will soon face another debt ceiling crisis and will likely need to trim federal spending or face another standoff with those who oppose raising the ceiling. When that happens, "you would have to go to the Affordable Care Act," Burgess predicted.

Congress will need about $1 trillion in spending cuts to avoid a debt limit increase.

The opening of federally subsidized insurance exchanges, scheduled to start in 2014, could be delayed, he explained. Federal support to states expanding Medicaid eligibility also could be in jeopardy.

Perhaps the upper limit on qualifying for subsidies would be lowered from 400% to 250%. "Maybe its 200% of the federal poverty level ," Burgess said. "The debt limit to require some substantial restructuring to the Affordable Care."

"The fact is the law is so flawed that it won't work under any circumstances regardless of who is president regardless or who is majority leader in the Senate," Burgess said. "This thing collapses under its own weight like you're trying to build a bridge to the moon."

In other health-related discussions at the town hall, Burgess said he will be pushing an extension of Medicare's sustainable growth rate (SGR) formula cuts in September. Physicians face a 27% reduction in payments come Jan. 2 unless Congress votes to delay the cuts.

Burgess says the Ways and Means Committee and Energy and Commerce Committee in the House of Representatives are working on long-term fixes to the SGR issue. "It will take some time to get that done and get that passed which is why another year's extension is needed," the Texas lawmaker said.

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.